Provider Demographics
NPI:1417055385
Name:ENDRES, DEBORAH ANN-MARIE (LLP, LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN-MARIE
Last Name:ENDRES
Suffix:
Gender:F
Credentials:LLP, LPC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN-MARIE
Other - Last Name:DERMIDOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:35455 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2236
Practice Address - Country:US
Practice Address - Phone:586-792-5335
Practice Address - Fax:586-792-3061
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007287101Y00000X
MI6301007765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist